Effectiveness of Medical-Behavioral Therapy in Patients with Fecal Incontinence

Guidelines recommend individualized medical and behavioral therapy (MBT) for fecal incontinence (FI), yet its effectiveness remains poorly defined. We assessed the response to MBT in FI.

In this 5-center U.S. trial, adults with FI received individualized MBT (dietary modifications, medications, and pelvic floor exercises) for up to 3 months. The primary outcome was a ≥75% reduction in FI frequency after 4 weeks of MBT. Secondary outcomes included 3-month FI, bowel habits, FI-related quality of life (QoL) and changes exceeding minimal clinically important differences (MCIDs).

Among 260 participants, FI occurred approximately once daily on average, more than one-third of bowel movements were incontinent, and nearly 25% had undergone anorectal procedures and/or colon resection. Sixty (23%) participants responded at 1 month but only 39 (15%) had a sustained response at 3 months; 200 (77%) were non-responders. At 3 months, FI-QoL also improved in sustained responders (P≤.006). Greater reductions in FI frequency were associated with a higher likelihood of exceeding MCIDs for FI frequency (P<.006) and FI-QoL lifestyle and coping subscores (P≤.04). In multivariable analysis, a greater response was independently associated with higher baseline FI frequency and no external anal sphincter defects (P=.0002). For a given reduction in Bristol stool score, FI frequency declined more among participants with more frequent baseline FI (P=.002).

Among patients with moderate-to-severe FI, 23% and 15% responded to MBT at 1 and 3 months. Responses at 3-months were clinically meaningful, associated with improved QoL, and more likely in patients with higher baseline FI frequency, and no visible external sphincter defects.